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For many, it’s almost mindless, a small break from the stress of their day-to-day lives.

But for David Todd, simply placing one foot correctly in front of the other is stressful.

“I can’t do things now that I used to in the past,” David said. “My endurance … I get tired easier than normal people. I get brain fatigue. Sometimes, it’s not that my body’s tired; it’s that my brain wants to shut down and recalibrate.”

Two days a week, David puts his brain and his balance to the test in the Norton Mobility Lab, using advanced technology and tools to regain his abilities. On this particular Tuesday, David is using the Gait Real-time Analysis Interactive Lab (GRAIL). It’s a multisensory system built for people with impaired walking.

He’s strapped in a harness, walking on a treadmill, looking at and responding to the virtual scenarios projected on the screen in front of him.

This has been David’s reality for nearly three years. Slowly but surely, he’s improving.

“I feel good [now],” David said. “We talk about neuroplasticity [the ability of the brain to reprogram itself after injury], and it’s true. You don’t see it now, but somewhere down the road, the switch is going to flip and then everything for the most part will be gone and you’re doing things now that you did before. You have to be patient and you have to keep working on it.”

‘My life had changed forever’

David’s life changed forever on July 3, 2022.

It was 2:45 a.m., unusually late for the self-described early bird. He and his wife were watching a movie on the couch. He began to feel weird.

David — who has Type 1 diabetes — thought this strange feeling was simply his blood sugar getting low. He asked his wife for his glucometer. She placed it in his right hand. He dropped it. Again, same result. Then a third time. Then David’s wife noticed he didn’t sound like himself. She told him he was slurring his words.

Worried, he stood up and walked clumsily to the bathroom, needing the wall for support. He looked at himself in the mirror and saw the droop in his face.

He knew what was happening.

“I knew it; I knew a stroke was occurring,” David said. “But how bad it was, I did not know. And I knew — on my way to the hospital — that my life had changed forever and there was nothing I could do. And that was stressful.”

David’s went directly to Norton Brownsboro Hospital, a Comprehensive Stroke Center certified by DNV. When he arrived in the emergency department, the only word he could say was “stroke.” It had been 40 minutes since his symptoms started.

David spent five days in intensive care, receiving blood-thinning medication to help treat his condition.

From there, he was discharged to begin the rehabilitation process.

‘This equipment is so vital’

David started at Norton Neuroscience Institute Cressman Neurological Rehabilitation, where the team provided outpatient physical, occupational and speech therapy three days a week. Eventually, he transitioned to Norton Specialty Rehabilitation Center – St. Matthews.

That’s where David was introduced to the Norton Mobility Lab and Robert Beury, M.Ed., a rehabilitation activity-based technician. Robert became David’s de facto personal trainer, working with his physical therapists to individually craft David’s therapy program and get his gait and balance back.

“I start very conservatively when we do our first bit of training,” Robert said. “And I have various speeds that I can put [David] at, the velocities of the interactions, and I keep track of how those change over time. As we kept going, we began to see the old numbers we were using weren’t challenging enough, and he was interacting more. Then he started to walk. And in time, we got to a point where we were doing all we could do.”

The two have been working together for roughly a year, using the GRAIL’s 10 motion-capture cameras to analyze and interact with specialized software. David was able to walk, reach, turn, balance and test his muscles with unique movements — all processes that can be difficult for stroke patients.

“It’s so daunting to get to a point where you are post-stroke, but the body begins to heal itself almost immediately,” Robert said. “So what it really needs is interaction. And that’s why I think this equipment is so vital, because it is interactive activity.”

The Norton Mobility Lab is the only facility in Kentucky with GRAIL gait analysis, allowing David and Robert a personalized approach to rehab. The dual-belt treadmill and virtual-reality environments allowed them to measure and analyze David’s walking pattern and target ways to improve it.

A Comprehensive Stroke Center

Every 40 seconds, someone in the United States has a stroke, according to the Centers for Disease Control and Prevention. That means there are more than 795,000 strokes each year in the U.S.

Stroke is a leading cause of long-term disability, and it’s estimated one person dies from a stroke every three minutes. But, advancements in medical treatment and increased awareness have improved both the survival rate and quality of life for survivors.

Stroke can affect almost anyone, so it’s important for people to take steps to reduce their risk, such as maintaining a healthy diet, exercising regularly, not smoking, and managing stress.

Norton Brownsboro Hospital offers extensive, comprehensive stroke care: It’s prepared around the clock to deliver lifesaving and brain-saving stroke treatment by restoring blood flow to the brain when seconds count.

The symptoms of stroke can be easiest to remember through the acronym BE FAST^*. They are:

• Balance — loss of balance, coordination or dizziness
• Eyes — having trouble seeing or change in vision in one or both eyes
• Face — uneven smile or face looks uneven, droopy or is numb
• Arms — one arm drops when raising both arms; numbness or weakness in one arm
• Speech — trouble speaking; slurred or difficult speech
• Time — Note the time when symptoms start: Time lost equals brain lost.
  
  *Adapted from Intermountain Healthcare. BE FAST was developed by Intermountain Healthcare, as an adaptation of the FAST model implemented by the American Stroke Association. Reproduced with permission from Intermountain Healthcare. Copyright 2011, Intermountain Healthcare.

What happens after a stroke?

A stroke typically happens suddenly, with no gradual progression.

That said, many patients will recover quickly and fully from a stroke. Some may have post-stroke conditions such as difficulty swallowing, weakness and paralysis, incontinence, difficulty speaking or understanding, emotional challenges, or poor attention span.

If a stroke happens on the right side of the brain, there may be left-side weakness, impulsiveness, overconfidence in abilities and vision issues to deal with. A stroke on the left side of the brain can be associated with weakness on the right side of the body, along with difficulty speaking, reading, writing or understanding language, and cautious behavior.

Norton Neuroscience Institute Resource Centers offer a number of services to patients recovering from strokes, including support groups, exercise classes, art and music therapy, and more. The effects of a stroke also can impact someone’s mental health. Changes and stress that come with caring for a stroke survivor can put caregivers and family members at risk for depression and anxiety.

“It’s important to remember stroke is a brain injury, and patients need a lot of reinforcement and repetition,” said Rosa Hart, BSN, R.N., SCRN, patient navigator with Norton Neuroscience Institute Resource Center. “So I’ll talk to patients and their families a lot about how to avoid stroke at home. And they may have received all of that information in the hospital, but they probably only remember a little piece of it. So knowing they have a human they can ask questions to when they don’t even know for sure what to do, helps them know they’re not left out on their own with no one to call.”

Rehabilitation services at Norton Healthcare offer specialized outpatient physical, occupational and speech therapy at locations downtown, on the Norton Brownsboro Hospital campus and on the Norton Healthcare – St. Matthews campus. These programs offer access to some of the most advanced technology and specialized services in one location to help with gait, balance, strength, flexibility, speech, fine motor skills, swallowing, driving, cognition, vision and more.

“Stroke symptoms may be reversed, but a lot of the time patients need that rehab after the fact,” Rosa said. “That could be in a facility for a while, until they get strong enough to go home. But we’ve learned, with neuroplasticity, the healing process can go on for years. So going to outpatient offices, giving access to physical, occupational and speech therapies to help people get back to their natural functioning, is really pivotal.”

‘Be positive all the way’

Nearly three years since his stroke, David continues outpatient physical, occupational and speech therapy, showing steady progress despite small, periodic setbacks.

He’s returned to his career at the Pleasure Ridge Park Fire Protection District, though he has shifted into an administrative role. He’s also slowly returned to his favorite hobbies, with a few adjustments. Cooking sessions are now completed under the watchful eye of his wife as sous chef. Hiking and backpacking are done with more caution, and the 5K races are run with an eye on finishing, not on time and speed.

Through it all, he’s thankful for the team that cared for him three years ago and continues that care today.

“We try something new every day,” David said. “We cook dinner more together and we do things differently. We have family help, so that’s important. But I have had a great team here. They’ve pushed me in ways that have helped make progress every step of the way. I tell people all the time, be positive all the way and keep going. Don’t stop.”

For more on David’s recovery journey, watch this video interview with David and Rosa.

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For some patients with high blood pressure, the nerves near the kidneys can become overactive. Applying radiofrequency energy to these nerves can help calm them, thereby reducing blood pressure. The new Symplicity Spyral renal denervation (RDN) system is the only one of its kind offered in the United States.

“We take a very thin tube into the artery that goes to the kidney and send electrical pulses to calm those nerves,” said Matthew J. Sousa, M.D., interventional cardiologist, Norton Heart & Vascular Institute. “It’s a simple, minimally invasive procedure that only requires minimal sedation, and the patient can usually go home the same day.”

Elevated blood pressure is a reading above 120/80 mmHg. For some people, blood pressure can reach a seriously elevated level categorized as advanced hypertension. Advanced hypertension, or Stage 2 hypertension, is defined as systolic (the top number) blood pressure of 140 mmHg or higher, or a diastolic (the bottom number) blood pressure of 90 mmHg or higher. This level of high blood pressure requires serious medical attention. If left untreated, stage 2 hypertension can lead to stroke, heart attack and serious damage to the kidneys, eyes and brain.

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What is hip replacement surgery?
The amount of pain you experience after surgery may depend on several factors, including type of surgery, the implants used and your overall health.

“Joint replacement procedures have a certain amount of discomfort no matter what,” Dr. Himschoot said.

There are different types of hip replacement or partial replacement surgeries. There are also hip resurfacing procedures that cap the bones with metal or ceramic implants, instead of replacing them with a synthetic joint. The goal of a hip replacement, either total or partial, is to restore or maintain movement and flexibility in the joint.

The causes of hip pain and damage can include:

• Osteoarthritis, which commonly occurs with normal everyday activity over time: Osteoarthritis damages the cartilage at the ends of the bones and helps joints move smoothly.
• Rheumatoid arthritis is caused by an overactive immune system, which creates inflammation that can erode cartilage and occasionally underlying bone, resulting in joint damage.
• Osteonecrosis is a less common condition, when there isn’t enough blood supplied to the ball portion of the hip joint, which can cause the bone to collapse and deform.

You also may need a partial or total hip replacement if you injure the joint. Hip fractures are more common as we age, especially in women. 

Hip replacement may be an option if your chronic pain:

• Persists, despite pain medication
• Worsens with walking, even with a cane or walker
• Interferes with sleep
• Affects the ability to walk up or down stairs
• Makes it difficult to rise from sitting down

Your doctor can help you decide whether you’re ready for joint replacement surgery.

Pain during and after hip surgery

You will be given anesthesia (pain management) for the surgery. Depending on your specific situation, you may be given a regional anesthetic, which blocks nerves to a certain part of your body. You are still awake during the procedure, but you may have a light sedative to help you relax. You may be given a general anesthetic, which acts on the brain and nervous system and puts your body to sleep. 

Immediately after surgery, you will spend time in recovery. There will be some pain and soreness at the incision site. There may be some bruising, and you may feel very tired. Your pain will be monitored and managed by hospital staff. You will get up to walk as soon as possible after the operation, using a cane or walker. Many people report feeling more pain on the second day after surgery.

“The goal is to stay a step ahead of your pain with ice or pain medication,” Dr. Himschoot said. “You will go home with prescriptions for your pain management and directions on how to use those medications, as well as other pain relief techniques.”

Your experience will be unique to you, but many people report:

• Discomfort in the hip for one to three months after surgery
• Discontinuing pain medication one to four weeks after surgery
• Resuming normal activity, with possible mild discomfort, in about six months
• Being pain free in about a year

Recovering from a hip replacement

Hip replacement recovery also may include:

•  Physical therapy (PT): You will start PT in the hospital after surgery and continue for several months. This includes stretches for mobility and strengthening exercises for the muscles around the new hip. 
• Assistive devices such as a walker or cane
• Nondrug approaches like ice, heat or massage.
• Medications including opioids, nonsteroidal anti-inflammatory drugs (also called NSAIDs) or other medicine.

Hip replacement recovery experiences vary from person to person. Factors that affect your pain levels include:

• Your individual tolerance for pain and discomfort
• Age, health and overall fitness level
• How well you follow your doctor’s instructions for your recovery after surgery, including for physical therapy and medications

Your surgeon and the rest of your medical team will be there to guide you through your hip replacement recovery and beyond. 

If you or a loved one has questions about minimally invasive hip replacement surgery and other replacement procedures, ask your doctor. They can help dispel myths about joint replacement, assess whether you may be a good candidate for hip surgery and help you choose an orthopedic surgeon.

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“This collaborative effort continues to elevate Norton Neuroscience Institute to a national stage,” said Gregory E. Cooper, M.D., Ph.D., neurologist and director of Norton Neuroscience Institute Memory Center. “It’s an affirmation of what we’ve already done, while also incentivizing us to continue pushing the limits of dementia and Alzheimer’s care in our community.”

The program funds a dedicated nurse navigator, Deborah Lockridge, R.N., BSN, CCRC, at Norton Community Medical Associates – Preston, whose job is to collaborate with primary care providers at the practice to identify patients who are at high risk and may be experiencing early symptoms of cognitive decline. The goal is to more quickly connect those patients with treatment at Norton Neuroscience Institute Memory Center and provide personalized education and support services along the way. The hope is to more efficiently diagnose and treat Alzheimer’s disease and other forms of dementia in their earliest stages. If the pilot proves successful, this clinical pathway may be used as a worldwide model for future Alzheimer’s care.

“This grant enhances the comprehensive care services we offer here at Norton Healthcare,” Lockridge said. “We all agree having a point of contact who can answer questions, encourage patients and caregivers and point them in the right direction is going to be a tremendous benefit to our community. We will use this opportunity to develop a collaborative, easy-to-navigate care model that can be scaled not just throughout Norton Healthcare, but across the country.”

Alzheimer’s disease is growing into a worldwide epidemic. According to the National Institute on Aging, more than 6 million Americans currently are living with Alzheimer’s, and more than 13 million will be living with the disease by 2060. The current care model requires multiple medical providers to coordinate to ensure patients who are eligible for disease-modifying therapies receive them during the early window of opportunity, when they will most benefit.

Yet, there are pathways for prevention, early detection and accurate diagnosis that could change the course of the disease forever. For example, in August 2023, Norton Neuroscience Institute became the first site in Kentucky to administer disease-modifying therapies to patients with mild cognitive decline and mild Alzheimer’s disease. In addition to early treatment, Norton Neuroscience Institute is actively pursuing brain health and prevention strategies.

“We’re very proud of our memory program and what we’ve created so far, but we know there is still much work to be done,” Dr. Cooper said. “We won’t rest until we’ve tried to perfect our system to quickly identify, diagnosis and treat people at the earliest possible stages, when we believe we have the greatest chance to slow this disease in its path.”

The six pilot sites will serve as start-up incubators for the development of materials and best practices for the program’s long-term sustainability and expansion — without the need for external funding. The learnings and resources from the Brain Health Navigator program will be incorporated into Davos Alzheimer’s Collaborative’s Early Detection Blueprint.

The other sites included in the program are Dartmouth Health (New Hampshire), Memorial Healthcare (Owosso, Michigan), Sharp Rees-Stealy Medical Group (California), UC Health (Ohio) and Keck Medical Center of USC, part of Keck Medicine of USC (California). Patients can schedule an appointment by calling (502) 446-4664 or visiting NortonHealthcare.com/MemoryCenter.

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• Hot flashes
• Night sweats
• Vaginal dryness
• Mood swings
• Sleep disturbances
• Fatigue
• Reduced libido

Menopause is a natural process — all women will go through menopause if they are advanced in age, or if they have experienced premature menopause due to a health condition, surgery or related treatment. The body has slowed or stopped producing hormones such as estrogen, testosterone and progesterone. There is no treatment for menopause; however, the symptoms of menopause can be managed with lifestyle changes and medical interventions. 

One such intervention is the use of hormone replacement therapy (HRT). Hormone therapy’s goal is to replace some of the hormones the body is no longer making enough of, or at all. The hormones replaced may include estrogen and progesterone. 

Hormone replacement therapy for menopause

Various hormones can be used in a variety of clinical treatments, such as for cancer, hormone imbalance or other conditions. HRT is the term usually used for replacing hormones lost or decreasing with menopause or perimenopause. 

There are two main types of HRT:

Estrogen replacement therapy involves taking only the hormone estrogen. It can be given in many forms, including pills; a patch that sticks to your skin; creams, gels, or tablets that go in your vagina; or a spray for the skin on your arm.

Combination therapy mixes estrogen and progesterone. Progesterone is also called progestin and includes natural and synthetic hormones that act like progesterone. People who still have a uterus need progestin. 

Benefits and risks of HRT

HRT prescribing practices have evolved in the last decades as more research has been done. There are risks to any hormone therapy, and there are also benefits that may outweigh those risks. 

Risks include:

The recurrence of cancer in some patients. Systemic estrogen is not recommended for women who have or have had breast cancer. You may be at a higher risk of developing a blood clot or for cardiovascular disease. 

Some factors that affect your risks include:

• How old you are when you start HRT
• The type of HRT prescribed
• Your overall health, including history of cancer
• Delivery method of HRT, such as a patch, vaginal cream or pill
• Whether you have had chemotherapy or radiation treatment
• Certain surgeries such as oophorectomy (removing one or both ovaries)

Benefits of HRT include:

• Easing menopause symptoms, such as hot flashes, bone loss, vaginal dryness and some mental health issues 
• Protecting brain health
• Increased sexual function
• Protecting bone health

What about DHEA?

Dehydroepiandrosterone (DHEA) is a naturally occurring hormone in the body, produced by the adrenal glands. DHEA helps the body make other hormones, such as testosterone and estrogen. DHEA declines with age, and with it, overall levels of the hormones it produces. There has been some investigation into DHEA to manage menopause symptoms, since DHEA is a crucial component in the body’s creation of the hormones HRT aims to replace. Researchers also have wondered if DHEA has antiaging properties.

While there is a link between low DHEA levels and symptoms of menopause, there is not enough evidence to support the use of DHEA as a frontline treatment of menopause symptoms. A 2022 meta-analysis of data in the The Journal of Clinical Endocrinology & Metabolism concluded that there are no consistent benefits of taking DHEA. According to the analysis, there may be some minor increases in quality of life or overall mood, but no impact on anxiety, sexual function, brain function or overall well-being in women. The researchers concluded that long-term use of DHEA may increase unwanted side effects in women such as acne and male-patterned hair growth.

More research is needed about the impact of DHEA on aging, menopause symptoms and other conditions. Always talk to your health care provider before taking any new medication or supplement. DHEA can interact negatively with drugs our supplements you are already taking, so it’s best to talk to a doctor before adding something new.

Is HRT right for me?

Your family physician or OB/GYN is the first place to start asking this question. Your health care provider will go over an appropriate course of treatment tailored to you.

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Brushing your teeth, pouring coffee, lifting food to your mouth — things millions of people do each day without a second thought. But for many who live with essential tremor, simple tasks like these can become impossible. The constant, uncontrollable body tremors can be embarrassing, frustrating and exasperating.

For as long as they can remember, Patrick Murphy and Bob Bender lived this struggle daily.

“As time has gone on, it’s become very obvious,” Patrick said. “I am constantly self-conscious about how [noticeable] it was. And then as soon as I think about it, it gets 10 times worse. You worry about people thinking, ‘What’s wrong with this guy?’ So it kind of builds on itself.”

The experience has been similar for Bob.

“It’s gotten so bad in the past year, that it’s become unbearable,” Bob said. “I will literally go some places and keep my hands in my pockets so people can’t see it. [I wonder if] people ask, ‘Is he going through detox? Is he on drugs?’ I mean, I think about that … I really do.”

After years of this struggle, Patrick and Bob finally found relief at Norton Neuroscience Institute, in the form of a new, incisionless brain surgery that relieved their tremor symptoms in a matter of hours.

On Nov. 13, 2024, Patrick and Bob were the first two people in the state of Kentucky to undergo high-intensity focused ultrasound treatment, sometimes called HiFU, for their tremors.

‘I see the frustration’

Patrick knew as a child that essential tremor was going to be an inevitable part of his future.

The disorder runs in his family, affecting Patrick, his father, brother, nephew and daughter.

“I remember watching my dad,” he said. “We used to work on cars together when we were younger. He would get way more frustrated than I do. But I can remember a lot of cuss words and throwing tools. It just makes you mad.”

Patrick officially was diagnosed with what was then called familial tremors in the early ’90s. Since his diagnosis, life has grown progressively harder.

“I wake up in the morning and immediately notice it,” Patrick said. “It can get better or worse throughout the day, depending on the day — doing things like drinking coffee, moving my mouse around the computer screen, little things.”

‘We do laugh about it, because that’s how we get through it’

“I see the frustration,” Patrick’s wife, Diane, said. “And he says he doesn’t get mad, but he does. In the beginning, I didn’t recognize it at all. But now, I really try to help. Sometimes it’s just easier if I do things, because he’ll spill it. Just watching him eat and miss his mouth [is so hard]. And we do laugh about it, because that’s how we get through it. But I know how frustrating it is.”

He tried several medications, but they didn’t work. He began scouring for a more permanent answer.

Patrick first discovered HiFU roughly five years ago, as he was researching new treatment options for essential tremor patients. He wanted to have the surgery immediately, but he’d have to travel to receive it. Plus, his insurance wouldn’t cover the procedure at the time. But this past summer, he learned Norton Neuroscience Institute had acquired the technology. He quickly scheduled an appointment with movement disorders neurologist Justin T. Phillips, M.D., at Norton Neuroscience Institute. Then Patrick underwent evaluation and was felt to be a good candidate for the surgery.

‘The things that I’ve stopped doing’

Bob noticed his tremors back in the 1970s. Small tremors were made worse by intense exercise. They were frustrating, but they were something he could live with.

In 2012, however, Bob’s life changed dramatically when he was involved in a motorcycle crash. Six months later, the tremors came on with a vengeance. They got progressively worse, affecting every aspect of his life. Roughly three years ago, they became insufferable.

“I don’t go out to eat; I don’t pour milk or coffee; I have to drink from a straw,” Bob said. “It’s unbelievable when you think about it, the things that I’ve stopped doing.”

A recent visit to the gas station showed how tremors can make otherwise routine tasks impossible.

Bob was there to buy some protein bars after a workout. He didn’t have cash at the time, forcing him to pay with his card. Only problem — his tremors prevented him from steadying his hand enough to fit his debit card into the card reader. The line was building up behind him. So was his embarrassment. Eventually, after a few seconds that felt like hours, Bob had to give his card and his PIN to the clerk, who completed the transaction for him. He ran out of the store and immediately changed his PIN.

“It was packed in there,” Bob said. “And there was a big line and they could see it. And it’s just so embarrassing. People are looking and saying, ‘What’s wrong with this guy?’ And I saw a lady and this guy just looking at me. I wanted to say something, because it’s irritating. But this is why I carry cash. That way, I can just pay in cash and if there’s change to give me back I just tell them to keep it for the next person. I don’t even keep track of my change. You have no idea how many times I just want to run out of stores and back to my car and not go in.”

Bob knew he needed help.

He visited with Jason L. Crowell, M.D., also a movement disorders neurologist at Norton Neuroscience Institute. Dr. Crowell explained HiFU and advised him on next steps. After a few evaluations, Bob was felt to be a good candidate for the procedure, to be performed by Abigail J. Rao, M.D., stereotactic and functional neurosurgeon with Norton Neuroscience Institute.

“I was nervous, but I was more excited than nervous to have it done,” Bob said. “When Norton Neuroscience Institute called me and told me they scheduled me to see Dr. Rao, I was shocked.

“I told her, ‘You’re going to be able to get me before Christmas?’ She said, ‘I believe I can do that.’”

What is HiFU

HiFU treatment, also known as high-frequency focused ultrasound or MRI-guided focused ultrasound, is an incisionless brain surgery, in which more than 1,000 ultrasound waves are focused down to the millimeter, creating heat that forms a small lesion, or ablation, in the tremor-causing area of the brain.

The roughly two-hour procedure is performed while patients are lying in an MRI machine. Brief, frequent scans monitor the location, size and temperature of the lesion as it’s created. Patients are awake and alert, allowing the surgeon to test the tremor and neurologic function in real time.

After the procedure, most patients experience dramatic and immediate relief of hand tremor and do not require a hospital stay. That said, the procedure only treats one side of the brain at a time, meaning some patients may wish to have a 2^nd surgery at least nine months later to treat the other side.

“This treatment’s exciting to participate in as a physician, because we see these immediate effects and we can interact with the patient,” Dr. Rao said. “I mean, that’s not why we do it, but instant results are part of what makes it satisfying. With a lot of our surgeries, we’re very happy with great outcomes, but we don’t always see them right then and there. So that’s part of what makes it really special.”

The HiFU procedure was approved by the Food and Drug Administration in 2016 after years of clinical trials to determine its safety and efficacy.

Norton Neuroscience Institute Cressman Parkinson’s & Movement Disorders Center is the only site in Kentucky to offer HiFU for essential tremor and tremor-dominant Parkinson’s disease. Norton Neuroscience Institute is also one of the first health care systems in the country to use an upgraded version of HiFU called Exablate Prime. This upgraded technology allows for a faster procedure and improves the patient’s comfort on treatment day. The technology was purchased with $2.8 million in funding through the Norton Healthcare Foundation.

“We have several patients who’ve reached out to us to learn more and are still considering their options,” Dr. Rao said. “And I think it’s only going to continue to expand. Another thing that will expand is its indications, meaning what we might be able to treat with this technology in the future. It’s really amazing to see. I mean, this is not the only or the first neurosurgical treatment that has immediate effects, but getting testable results that don’t involve any implantation into the brain, or even incision, is very exciting.”

Bob: ‘I am 100% happy’

The surgery was successful for both Patrick and Bob.

Within two hours after surgery, each stood up from the MRI scanner and walked out. As friends and family looked on in tears of joy, and as the clinical team removed the patients’ helmets, the two men looked down at their hands.

For the first time in years, they didn’t shake.

Both Patrick and Bob performed simple post-procedure tests _— drawing spirals, signing their names, even drinking water from a bottle. No shakes. No spills. The improvement was dramatic. The two men stayed for roughly an hour to be monitored for any side effects.

When they were cleared to go, the two men walked out of the hospital visibly changed, ready to do the little things again _— go out to dinner, pour a cup of coffee, put their debit card in a card reader.

For the first time in decades, Patrick and Bob finally felt steady.

“I just want everybody to look at it,” Bob said. “I just want everybody to see it. I mean, it was crazy. It was just … it’s unbelievable. I still can’t wrap my mind around it. I am 100% happy. Emotional, of course. It’s crazy.”

Patrick: ‘Feels like it’s normal’

“It feels amazing,” Patrick said. “It feels like it’s normal, the way I should be. [I’m] just looking forward to people not being able to see me shaking and thinking, ‘Wow, is this person really nervous?’ So that’s the biggest thing — being still in just about everything I do.”

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Vascular integrity and blood flow

The brain is an energy-intensive organ, accounting for about 20% of the body’s total oxygen demand. The heart supplies oxygenated blood to the brain through a vast network of blood vessels. If the heart or vascular system is compromised, this can limit the brain’s oxygen and nutrient supply, impairing cognitive functions over time. Conditions such as high blood pressure, heart disease and hardening of the arteries can reduce the elasticity of blood vessels or lead to blockages, which may prevent adequate blood flow to the brain. These interruptions, in turn, can lead to brain cell damage, stroke and cognitive impairment.

Research also has shown that high blood pressure, particularly in midlife, is a major contributor to the risk of developing vascular dementia and other forms of cognitive decline. When blood pressure remains consistently elevated, it can damage the small vessels that supply critical areas of the brain responsible for memory and decision-making, causing “silent” ministrokes that impair mental function.

Shared risk factors between heart and brain health

Heart disease and cognitive decline share numerous risk factors, which partly explains their close association. Major factors include high cholesterol, high blood pressure, diabetes, smoking, obesity and physical inactivity. Each of these conditions can damage blood vessels, making it difficult for the heart to maintain proper blood flow, which impacts the brain as well. Additionally, inflammation plays a central role; it damages blood vessels, leading to plaque buildup and narrowing of the arteries, affecting the cardiovascular system as well as cognitive function.

Diabetes has a strong correlation with both heart and brain health. High blood sugar levels can damage blood vessels over time, leading to complications like heart disease and an increased risk of Alzheimer’s disease. Insulin resistance, often associated with diabetes, also may impact the brain’s ability to utilize glucose efficiently, which can lead to impaired cognition.

Lifestyle changes and preventive measures

The good news is that many lifestyle choices that protect the heart also benefit the brain. Regular physical activity, for instance, strengthens the cardiovascular system and improves blood flow to the brain. Exercise has been shown to boost mood, reduce stress and support neurogenesis, the process by which new brain cells are created, particularly in the hippocampus — the brain region associated with memory.

A brain-healthy and heart-healthy diet, such as the Mediterranean diet, which is rich in fruits, vegetables, whole grains and healthy fats, also has been linked to better cognitive outcomes. Foods like fish, nuts and olive oil provide essential nutrients like omega-3 fatty acids and antioxidants, which have anti-inflammatory properties that benefit both heart and brain health.

There are also lifestyle changes you can make to help ward off dementia or other types of cognitive decline. These include the above diet and exercise changes, but also social interaction, stopping smoking and other modifications.

Maintaining a healthy heart is essential for protecting the brain. The connection between these two vital organs is largely based on their shared reliance on a healthy vascular system, along with common risk factors. By focusing on lifestyle adjustments like exercise, balanced nutrition and managing chronic conditions, you can reduce your risk for cardiovascular disease and cognitive decline simultaneously. Through these proactive measures, it’s possible to support both heart health and brain health, promoting a longer, healthier life.

Have concerns about your brain health? Take this short quiz

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If you have blood in your stool, a fever or unexplained weight loss, talk with your primary care provider about your symptoms.

Diarrhea, bloating and abdominal pain are signs that your gut health may be out of balance. Maintaining a healthy gut benefits your body far from your gastrointestinal tract. Gut health influences your immune system, brain function, weight and more.

“A healthy gut is really a healthy gut microbiome. The microbiome is a liquid organ in your digestive tract that needs a diversity of gut bacteria, viruses, fungi and other microorganisms to help break down food and metabolize it into energy while supporting the immune system and influencing the gut-brain axis,” said Joshua H. Brandon, M.D., family medicine physician with Norton Community Medical Associates primary care.

Gut dysbiosis happens when the gut microbiota — the microorganisms that make up the microbiome — are out of balance. For example, there may be too little good bacteria or too much bad bacteria.

An unhealthy gut microbiome can hamper your immune system, making you more susceptible to infection. Digestive system issues such as irritable bowel syndrome, constipation, diarrhea and bloating can arise from an unbalanced gut microbiome. And the gut-brain axis — the network of nerves sending signals between your gut and your brain — chiefly controls digestion and can affect mood, including anxiety and depression.

The basics of good gut health start with eating right, exercising and drinking plenty of water.

Healthy eating

Eating a healthy diet with fiber and fruit while avoiding processed foods and too much alcohol contributes to a healthy gut. Look for foods that contain fiber, prebiotics and probiotics.

Keep in mind that processed food includes chemical processing and mechanical processing. Packaged food often has large amounts of saturated and trans fat, added sugar, salt, and food additives that affect the gut.

Even mechanically processed foods can have an impact. Smoothies, with lots of fruit, might seem like a good choice. But in a liquid, the sugar in the fruit hits your system faster than whole fruit and produces a blood-sugar spike. That prompts your pancreas to send out insulin and sends a pleasurable signal to your brain, prompting you to crave more. And since the liquid passes through your system quickly, you may get hungry sooner, even though the smoothie was high in calories.

Here are some examples of foods that promote a healthy gut microbiome:

• Fibers: Whole grains like oatmeal and beans help food move through your digestive system. An important role of dietary fiber is to prevent constipation and support the movement of food through your body. Fiber adds bulk and absorbs water, which makes stool softer and easier to pass. Fiber can help you feel full, slow digestion, clear out your colon and improve gut health.
• Polyphenols: These are found in plants, so vegetables, fruits and whole grains have polyphenols. Particularly good sources of polyphenols are certain berries, herbs, spices and nuts.
• Naturally fermented foods:  These introduce probiotics, or healthy bacteria, into the digestive system. Examples of fermented foods include sauerkraut, kimchi and yogurt with live cultures.
• Healthy fats: Unsaturated fatty acids increase microbiome diversity. Examples of foods rich in unsaturated fats include avocados, almonds, cashews, pecans, pistachios, pumpkin seeds, sesame seeds, sunflower seeds and olive oil.

Exercise

Moderate and intense exercise, combined with a healthy diet, has been shown to improve digestive health. Exercise has a positive influence on how the cells in our body regulate energy production, expenditure and food intake. Metabolism, or how your body converts food into energy, is an important role for your gut microbiota.

The exact cause of the link between exercise and healthy gut microbes is being researched. High-intensity exercise brings more oxygen into the bloodstream, and this may help good bacteria flourish in the gut. Low intensity exercise may help the gut by encouraging the digestive tract to move food through faster.

A study found a link between a healthy microbiome and motivation to exercise (in mice, at least).

Water

Adequate hydration is important to overall health as well as the growth of a healthy gut microbiome and may contribute to diversity in the gut microbiota. Drinking water during or after a meal aids digestion and helps food move through the digestive tract.

In addition to water, hydrating foods include watermelon, cucumbers, oranges and berries Caffeine and alcohol, however, are diuretics that increase fluid loss.

Your urine should be a pale, light yellow. Darker urine suggests you need to drink more water.

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What is a ‘healthy brain’?

A healthy brain has optimal structure and function that leads to social, mental and physical well-being. The brain retains cognitive function and has little or no memory loss. 

Christopher B. Shields, M.D., has been focused on the links between lifestyle and brain health for quite some time. As a neurosurgeon and chairman of Norton Neuroscience Institute, he has a vested interest in educating the community on dementia and memory loss. 

RELATED: The connection between heart and brain health is key to overall wellness

Here are some of Dr. Shields’s guidelines for ways to potentially delay the onset of diseases like dementia and Alzheimer’s and keep your brain healthy:

1. Chow down on brain food. In general, people should drastically reduce the amount of sugar, carbohydrates and starch in their diets, especially that found in processed and fast foods. Eat a good amount of high-protein foods from sources like salmon and chicken, and include good fats. Also include fresh vegetables, vitamin B and omega-3 and omega-6 fatty acids.
2. Get good sleep. Adequate sleep has been shown to keep some diseases at bay, including diabetes. It also can help with depression, anxiety and weight maintenance.
3. Get moving. It may seem that every doctor tells you exercise will fix whatever ails you. Physical activity does seem to have benefits across the board, from building muscle and lung function to strengthening the heart and relaxing the mind. Even walking for 20 minutes a day five days a week can improve the body. 
4. Mental health is important, too. Emotional coping mechanisms are critical to overall health. Work on reducing stress and building emotional resiliency. Meditation, reading self-help books and watching motivational videos are all ways to keep your mind healthy.
5. Pump some iron. You don’t have to bench press a bulldozer, but weight-bearing exercise and lifting weights can help maintain bone and muscle as we age.
6. Maintain a healthy weight. Weight causes the body to age faster. A healthy, high-protein/low-sugar diet slows aging and possibly can ward off dementia for a time.
7. Check your gut. There are about 10 times as many bacterial cells in your gastrointestinal tract as there are cells in your whole body. These bacteria produce your own unique gut microbiome, the contents of which can affect your mood, personality, behavior and more. Consuming foods like kefir that support a healthy gut microbiome can be extremely good for you.

Heart health is also linked to brain health. You may be more likely to develop cognitive impairment if you have heart conditions such as heart disease or heart failure. The above steps can help with heart health, too. 

To sum it up, Dr. Shields said, “There are things we can do earlier in life that can really beneficially affect our health and delay or prevent dementia.”

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